Towards the global elimination of cervical cancer

Abstract

Two very effective prevention strategies for cervical cancer exist – vaccination against the human papillomavirus (HPV) and cervical screening with primary HPV testing followed by treatment of precancerous lesions. In 2018, the World Health Organisation called for action towards achieving the global elimination of cervical cancer, and a strategic plan encompassing elimination goals and targets for the scale-up of HPV vaccination, cervical screening and precancer and cancer treatment, particularly in low and middle income countries, will be presented to the 2020 World Health Assembly. The first published estimates suggest that achieving rapid scale-up of both vaccination and twice lifetime cervical screening in all countries would avert up to 13.4 million cervical cancer cases over the next half century, with the majority (but not all) countries achieving incidence of <4 per 100,000 women by 2100. However, there are significant challenges - (i) including vaccine manufacturing pipeline, supply, delivery and hesitancy, (ii) cervical screening HPV self-collection and point-of-care evaluation, acceptability, and scaling up effective precancer treatment processes, (iii) configuration of appropriate referral pathways, cancer treatment services and palliative care for those women who do develop cervical cancer, as well as (iv) the effective financing of both HPV vaccination and cervical screening on a large scale. It is hoped and anticipated that the WHO elimination initiative will galvanise concerted action to address these issues.